Lower-limb wound evaluation and care in the vascular surgery patient.

This issue of Seminars in Vascular Surgery is devoted to the evaluation and management of lower-limb wounds in the vascular surgery patient. In-depth discussions of common clinical conditions are presented on the topics of venous ulcer, diabetic foot infection, peripheral arterial disease (PAD) with tissue loss, and surgical site infection (SSI). The first article by Scalise et al discusses the role of bacterial biofilms and the wound microenvironment on healing. The treatment of surface bacterial biofilms is critical to the treatment of all lower-limb wounds and for the prevention of SSI. When a chronic lower-limb wound is encountered, its evaluation and management require a multifaceted approach that addresses the complex factors involved in the healing process of cellular proliferation and angiogenesis. These authors detail the biofilm-based strategies that should be considered for healing lower-limb wounds caused by trauma (diabetic foot ulcer), venous insufficiency, and PAD. In their article on the management of venous ulcer, Cooper et al detail the disability of this common vascular condition, including its associated decreased quality of life, reduced mobility, and social isolation. Treatment of this vascular lower-limb wound requires wound debridement, treatment of biofilm infection, compression therapy, and a wound environment conducive for healing. These authors emphasize that collagen and antimicrobial dressings can accelerate ulcer healing. Current vascular surgery practice is to eliminate venous duplex ultrasound documented truncal superficial (great and small saphenous, perforator) vein reflux when ulcer healing has not been achieved within a 3month period of compression therapy and wound care. The evaluation of patients with diabetic foot ulcers is addressed in two articles. The health-related quality of life in these patients is detailed in the article by Sekhar et al, with emphasis on both the physical and mental health aspects. The presence of a foot ulcer in a diabetic patient is a limbthreatening condition and requires the health care team to provide patient-specific education and wound care. In a companion article by Nteleki et al, the contemporary